


Mental Health in the All For the Game Series

by frog2522



Series: fic research and writing [1]
Category: All For The Game - Nora Sakavic, No Fandom
Genre: Abuse, Drug Withdrawal, Essays, Fanwork Research & Reference Guides, Gang Violence, Grief/Mourning, Guides, Implied/Referenced Rape/Non-con, Mental Health Issues, Nonfiction, Period-Typical Homophobia, Post-Traumatic Stress Disorder - PTSD, Research, Writing
Language: English
Status: Completed
Published: 2021-01-18
Updated: 2021-01-23
Packaged: 2021-03-16 11:20:22
Rating: Teen And Up Audiences
Warnings: Graphic Depictions Of Violence
Chapters: 9
Words: 6,584
Publisher: archiveofourown.org
Story URL: https://archiveofourown.org/works/28830306
Author URL: https://archiveofourown.org/users/frog2522/pseuds/frog2522
Summary: Research surrounding mental health in all for the game, for both character analysis and fic research. Can be used beyond the aftg fic writers if you are looking for any information on street gangs, assault, ptsd, grooming or addiction.I've never studied psychology, everything in this is my own research from reading academic journals and articles online, and is for the use of fiction writing reference. Feel free to correct me on any misinformation, tell me your theories and make any suggestions.
Series: fic research and writing [1]
Series URL: https://archiveofourown.org/series/2113935
Comments: 10
Kudos: 9





	1. Renee Walker - gangs

**Author's Note:**

  * Inspired by [Call Me Mara](https://archiveofourown.org/works/29058678) by [frog2522](https://archiveofourown.org/users/frog2522/pseuds/frog2522). 



> This doesn't go into a lot of detail, I simply summarised my own notes on the topics. At the end of each chapter will be a small list of reference texts you can access for free online. If you are planning to use this as reference for your own fics, please also know this is academic information and you should read blogs and personal stories of people's experiences. That being said, I hope you enjoy and I'd love to read you own thoughts and interpretations of the characters x

I adore the AFTG series with every ounce of my being but Nora Sakavic's lack of research and udnerstanding of mental health is kinda obvious. For the most part I am writing from my fan theories and pulling up context that was not included. For example grooming, sports abuse and Renee's involvement with gangs. Renee's backstory isn't really given in as much detail as I think she deserves. The little I can find is either from the series or Sakavic's short series on tumblr 'Son Nefes'. What we do know is that she became part of a gang at 10, killed the man who was sexually assaulting her and was arrested sometime after for drug use before being fostered and eventually adopted by Stephanie Walker. In my own fic 'Call me Mara' I took this and just extended it, looking into withdrawal, drug use in the 90's, gang violence etc. 

Street gangs: 

\- “Groups of young people who see themselves (and are seen by others) as a discernible group for whom crime and violence is integral to the group's identity.”  
Organised criminal gangs  
\- “A group of individuals for whom involvement in crime is for personal gain (financial or otherwise). For most crime is their 'occupation’  
\- It's not illegal for a young person to be in a gang – there are different types of ‘gang’ and not every ‘gang’ is criminal or dangerous. However, gang membership can be linked to illegal activity, particularly organised criminal gangs involved in trafficking, drug dealing and violent crime.  
\- County Lines is the police term for urban gangs exploiting young people into moving drugs from a hub, normally a large city, into other markets - suburban areas and market and coastal towns - using dedicated mobile phone lines or “deal lines”. Children as young as 12 years old have been exploited into carrying drugs for gangs. This can involve children being trafficked away from their home area, staying in accommodation and selling and manufacturing drugs.  
\- Cuckooing - gangs taking over a resident’s (often vulnerable person) home - often to house activity etc. Children living in these environments are subject to neglect  
The Law of Joint Enterprise  
Many of the policies put in place are targeted at the threat young people pose rather than the threats young people face - this is problematic, stigmatising young people as a group and stunting their social life by creating fear and often abuse around their want to hang out in groups in public.  
\- Research suggests that young people who perpetrate group-based offending and violent behaviour will often have been the victims of abuse or neglect; many end up in gangs as a form of defense. Many face poverty, inconsistent parenting, homelessness, reduced education and the policies can reduce their life chances often trapping them in a cycle of crime and gangs as a form of defence  
\- Gangs in the US are usually segregated along racial lines, use strict rules or “honour codes”, deploy coercion to recruit and retain members and engage in high levels of violence and criminality  
In recent times, members of the media, politicians and policy makers have applied the term “gang” broadly, to describe the activities of many groups, ranging from informal groups of young people who spend their leisure time assembled in the street (Aldridge et al, 2008), to members of organised criminal units (Smith and Bradshaw, 2005). The loose application of the term reflects the fact that there is currently no commonly held definition of what constitutes a gang.  
\- “a combination of their collective risk factors, a mutual need for acceptance by their peers and the opportunities available to them (or the lack of acceptable alternatives), mean that norms within the group may tend generally to be anti- rather than pro- social, and the activities they engage in together can easily cross the threshold into minor offending.” (Young et al, 2007).  
\- There are many speculated reasoning behind young people joining organised crime groups and street-gangs however the largest factor proven is that young people feel unsafe.  
“respondents explained [that] gangs were less likely to attack someone who was in a group, and that friends could offer support or run for help if something happened.” (Turner et al 2006)  
\- The most successful way to lower the crimes committed by young people was prevention through mentoring programs, creating supportive social bonds between young people, secure and long lasting relationships with authorial adults (teachers and parents/guardians), community role models. People at risk of poverty and social exclusion are more at risk of gang related violence and crime, decreasing the effect of poverty on young people’s lives and giving them access to enrichments and social inclusion in communities could be a key way to help young people  
\- Groups of young people from the African-Caribbean community are nevertheless more likely to be labelled as “gangs” or perceived to be criminal suspects than their white counterparts (House of Commons, 2007; Young et al, 2007; Phillips et al, 2006), although at the same time, working-class young people from certain “problem” areas are also more likely to be regarded as such, regardless of ethnic background. However because of the complex reasoning many enter gangs or engage in weapon based violence there is no ‘one size fits all’ solution. Instead we must cater intervention to the young person’s personal experiences, using a mix of child protection, education and peer-based techniques to decrease the need for crime-based gangs to form as a method of self defence. It is unlikely that authoritarian methods would be effective and could cause a larger issue and harm the communities in the long-term.  
\- the personal and institutional discrimination faced by children on the basis of their ethnicity, age or postcode may have an unintended impact on offending behaviour - they may react on a sense of personal injustice and there are concerns that through labelling young people there becomes a sense of ‘self-fullfilled prophecy’ 

NSPCC, (undated). Criminal exploitation and gangs [online]  
Public Safety Canada, (2018) Youth gang involvement: What are the risk factors?


	2. Adolescent Trauma (brief)

This covers most of the characters' backstories and isn't specific to any one type of traumatic experience. As many of the characters are young adults, they will still have most of these symptoms in canon, however moving into the future there will be slightly different symptoms with their PTSD and other trauma-related difficulties. I have simplified my research rather than write 50000 words on it so it doesn't cover everything. 

\- Typically, the effects of trauma in teens include fear, anger, withdrawal, and isolation. Suffering from trauma may cause your child to exhibit reckless and dangerous behaviors. Depression, hopelessness, and flawed reconstruction of memories can also be a consequence of trauma.  
\- Overacting you’re minor irritations  
\- Disturbed sleeping pattern  
\- Being very protective of family and friends  
\- Loss of interest in hobbies, school, friends  
\- Difficulty in short-term memory and problem solving

Teen PTSD:  
\- Respond recklessly, abusing drugs and alcohol  
\- Withdraw from activities, places and friends in an effort to avoid reminders  
\- Fear that their strong reactions mean they are “going crazy”  
\- Feel stigmatized by having gone through traumatic events, and feel they cannot talk about them  
\- Difficulties regulating emotions  
\- Shame and guilt  
\- School failure  
\- Brain is occupied with intrusive images of traumatic events and cannot focus on school  
\- Emotionally overwhelmed cannot devote energy to forming relationships with peers  
\- Fear of taking risks cannot take challenges that lead to growth 

Better Health Channel, (2016). Trauma and teenagers - common reactions  
The National Child Traumatic Stress Network, (2008). Understanding the Links Between Adolescent Trauma and Substance Abuse


	3. Kevin and Jean - Child Grooming and Abuse in Sports

This may be seen as a bit of a stretch but trust me on this. Having grown up in an athletic environment, Kevin and Jean would most likely encounter the darkest parts of the sports industry which occur both at community level and Olympic professionals. I mention also Alison in terms of the pressure surrounding appearances. 

Sexual harassment and abuse have become accepted as problems within the sports industry since the early 1990s. Many of it comes from children and adolescents being groomed for sex by their (predominantly) male coaches. Often the coach nurtures and protects their victim is a parent-like relationship, providing a mixture of discipline and affection upon which the athlete gradually becomes reliant. The power given to the coach over their athletes offers an effective alibi for the conscious abuse strategy, whilst their victim is an unwitting party to the gradual erosion of the interpersonal boundaries.  
The physicality of sport requires not only close proximity of bodies in states of  
undress and/or exertion but also intimate actions that might, in non-sport contexts, be  
regarded as invasive. In this way, sport also fosters a degree of interpersonal closeness  
between athletes and coaches that might otherwise only be seen within the family or care  
home settings.  
Alternatively, in some cases the fear of the consequences of what would happen if victims do not cooperate with their abusers replaces the need for infatuation. This can take many forms from pornographic footage used as blackmail, violent physical abuse or simply being kicked out of competition. The parent-child-like relationship also makes it easier for people in positions of authority to guilt their abusers, especially if they implemented a paternal management style to the whole team. Seeing the team as a “family” means that every player is responsible for the failures, and targeting one specific player will often have a domino effect if other players are scared of being associated with the victim and becoming victims of the abuse themselves.  
Abuse within sports does not just cover sexual exploitation of athletes. For many athletes, especially Olympians, their coaches and peers can push them to complete over-training with the fear of punishment or deselection. This is an extremely dangerous practice, made worse by the strict and often damaging diets and coach comments on the weights and looks of many female athletes (think Alison). This causes the ongoing rise in eating disorders in young athletes and mental health problems caused by the physical exhaustion these athletes experienced (look into Great Britain's female gymnasts’ stories).  
In high-performance environments, where athletes are fine-tuned to push themselves to physical and mental limits, abuse can go unnoticed or be deemed “what it takes” to reach the highest levels of performance. The culture surrounding these environments often make athletes feel like they have little choice but to ignore pain, play through major injuries and do whatever it takes in the pursuit of success.  
Because success is so desired, when it is achieved, uncompromising coaching practices in abusive coach-athlete relationships may be re-imaged as effective coaching. Many athletes fear speaking out against these environments and abuse in fear of deselection and the consequences speaking out could have on their career.  
On top of the obvious immediate impact of the abuse, many athletes end up with chronic injuries due to overuse and training or competing through injuries. 

Although the series never mentions sexual abuse of Kevin or Jean (as far as I remember, correct me if I’m wrong), they had similar experiences in this family-dynamic abuse. The fear of being associated with the victim is made stronger with the Nest’s partner system of collective punishment and increases the chance of abuse from other victims (the other Ravens). The “do whatever it takes” mentality is clear in both Kevin and Riko respectively from being raised completely immersed in this environment, we see it often in how Kevin treats his teammates and his constant night practices with Andrew and Neil. 

Virtual College. (2020). The grooming process in sport  
Brackenridge, C. and Fasting, K. (2004) The Grooming Process in Sport: Narratives of sexual harassment and abuse  
Kavanagh, E. et al. (2020). Winning at all costs – how abuse in sport has become normalised  
Possible further reading: the death of Choi Suk-Hyeon


	4. Andrew and Renee -  (child) sexual abuse and harassment

This is a reminder that both Andrew and Renee had some similar experiences growing up, being victims of sexual abuse/assault is just one of them. Obviously both characters experience this abuse in very different environments and at different stages in their lives. Whilst Renee was assaulted by a gang member, Andrew most likely experienced several cases of grooming with both Drake and his past foster parents. These different experiences despite the same crime means they deal with the trauma very differently in their day-to-day lives. Andrew has not been able to recover from it in a safe environment like Renee was able to in her her teen years and is still processing these events. That being said, I don't think Renee was given enough of a character in the books for us to see the depths in which she deals with her trauma. We do not know if she still has PTSD from the events and night terrors but we can assume that is most likely the case. 

Authors describe the difference between sexual abuse and harassment depending on their own personal views on such. I have chosen to take the definitions from Brackenridge and Fasting’s article.   
Harassment: Unwanted attention on the basis of sex   
Abuse: groomed or coerced collaboration in sexual and/or genital acts where the victim has been entrapped by the perpetrator 

\- Childhood sexual abuse has been correlated with higher levels of depression, guilt, shame, self-blame, eating disorders, somatic concerns, anxiety, dissociative patterns, repression, denial, sexual problems, and relationship problems.   
\- Survivors often experience guilt, shame, and self-blame. It has been shown that survivors frequently take personal responsibility for the abuse, body issues and eating disorders have also been cited as a long-term effect of childhood sexual abuse  
\- Sleep and eating irregularities   
\- Chronic anxiety, tension anxiety and phobias   
\- Common relationship difficulties that survivors may experience are difficulties with trust, fear of intimacy, fear of being different or weird, difficulty establishing interpersonal boundaries, passive behaviours, and getting involved in abusive relationships   
\- Therapists are recommended to address the more general psychosocial problems before treating the sexual problems of survivors. This is due to the sensitive and vulnerable nature of sex. Survivors are more likely to experience success in sex and relationship counselling after resolving feelings about the abuse and gaining skills in areas such as assertiveness and self-awareness 

Grooming:   
Grooming is a common strategy used by abusers to build a close relationship with their victim, often to build trust and an emotional connection so they are easier to manipulate. This was mentioned in the chapter about the sports industry, but it takes a more intimate form when it is done by a family member or guardian such as in foster home situations. As stated in the sports grooming chapter, abusers will often use tactics such as showing understanding, giving advice, buying gifts, showing affection, and contrasting this with the fear of the consequences of what will happen if they don’t cooperate. They may also try to isolate their victims to build a sense of complete dependence or use blackmail to guilt and shame their victims as an intimidation technique. 

Effects of grooming:  
\- Anxiety and depression   
\- PTSD   
\- Eating disorders   
\- Suicidal thoughts   
\- Self harm  
\- Difficulty coping with stress   
\- “Shame and blame” (feeling like it's their fault)   
\- STI   
\- Substance dependency   
\- Relationship problems with family, friends and partners 

Brackenridge, C. and Fasting, K. (2004) The Grooming Process in Sport: Narratives of sexual harassment and abuse  
Hall, M., & Hall, J. (2011). The long-term effects of childhood sexual abuse: Counseling implications

**Notes for the Chapter:**

> if this is something you want to explore, I highly recommend Luna_Moon_26_20 ‘s fic ‘This might be a little out of hand’. It does deal with some heavy topics and graphic scenes but it is beautifully written and I cry every time I read it just because of how close it hits to home.


	5. Drug Abuse, Risks, and Withdrawal

**Summary for the Chapter:**

> this is very nonspecific and can cover pre-canon Aaron, Renee, and Matt, as well as canon Seth, Andrew and Kevin. At the end is a small paragraph on my theory on cracker dust

Drugs and transmitted diseases:  
People who engage in drug use or high-risk behaviours associated with drug use put themselves at risk for contracting or transmitting viral infections such as human immunodeficiency virus (HIV), acquired immune deficiency syndrome (AIDS), or hepatitis. This is because viruses spread through blood or other body fluids. It happens primarily in two ways: (1) when people inject drugs and share needles or other drug equipment and (2) when drugs impair judgement and people have unprotected sex with an infected partner.  
According to the CDC, one in 10 HIV diagnoses occur among people who inject drugs  
Being infected with HIV does not automatically mean that it will progress to AIDS. A patient is diagnosed with AIDS when identified with one or more infections and a T cell count of less than 200  
Drug use can worsen the progression of HIV and its symptoms, especially in the brain. Studies show that drugs can make it easier for HIV to enter the brain and cause greater nerve cell injury and problems with thinking, learning, and memory. Drug and alcohol use can also directly damage the liver, increasing risk for chronic liver disease and cancer among those infected with HBV or HCV.  
Sharing of drug equipment, i.e. contaminated needles.  
multidimensional family therapy—developed for adolescents with drug abuse problems as well as their families—which addresses a range of influences on their drug abuse patterns and is designed to improve overall family functioning

Withdrawal:  
Withdrawal symptoms vary depending on what substance someone is dependent on. Stimulants like cocaine and methamphetamine normally produce psychological symptoms, while alcohol, most prescription drugs, and heroin can cause a range of physical and psychological symptoms.  
Common symptoms could include:  
\- Nausea and vomiting  
\- Bone and muscle pain and tension  
\- High temperature and/or chills  
\- Restlessness  
\- Vivid, unpleasant dreams (night terrors)  
\- Headaches  
\- Heart palpitations  
\- Sweating  
\- Shivering and shaking  
\- Seizures  
\- Increased blood pressure  
\- Increased appetite  
\- Anxiety  
\- Agitation  
\- Insomnia  
\- Depression  
\- Hot and Cold flushes  
\- Hallucinations  
\- Diarrhoea 

Drug withdrawal is a terrifying, painful and life-threatening experience for someone to go through. There are detox methods available that can help ease symptoms and the risks, for example people who suffer from heroin and painkiller addiction can receive medication in drug detox that relieve drug cravings and other opioid withdrawal symptoms.  
Those who suffer from addiction to prescription drugs like benzodiazepines, amphetamine, and sleep aids can be put on tapering schedules to avoid withdrawal. Tapering is when doctors reduce doses of these drugs gradually over a period of time until patients are no longer using these medications. Tapering schedules and medication management are included as part of drug detox.

Post-Acute Withdrawal Syndrome:  
After detoxing from the addictive substance and managing through the withdrawal symptoms state previously, sometimes after a month or two after symptoms have subsided people will start to feel edgy and antsy. They will experience sudden mood swings, trouble sleeping or sleeping too much or the vivid, unpleasant dreams will return. It's a fairly common experience that can lead to a second phase of withdrawal symptoms or a lapse in craving. It's important to note this lapse is not a relapse unless they return to their addictive habits. It is also common for people in recovery to start feeling anxious and having panic attacks and concentration issues. 

WTF is Cracker Dust? 

Cracker dust doesn’t exist in our world, in fact if you google it you will find it's what created cement and artificial lawns, the nickname instead probably comes from the salty taste and dehydrating effect it has. As far as I can tell, cracker dust is a stimulant that leaves the person energetic, alert, active and excited. Stimulants speed up the central nervous system, examples being cocaine and caffeine respectively. Sakavic describes the drugs to give the person a “rush” similar to that of other stimulants and similarly can make people talkative and disoriented. Despite stimulants being historically a common medical treatment to increase soldier alertness and insomnia, today stimulants are only used for a small number of medical conditions such as ADHD, narcolepsy, and occasionally depression. The obvious side effects besides nausea and dehydration is that stimulants are known to cause psychosis and paranoia in repeated use, despite the fact the drugs are not addictive.

National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction  
National Institute on Drug Abuse. (2020). Drug Use and Viral Infections (HIV, Hepatitis) Drugfacts  
Nationwide Children’s’ (undated). Addiction  
UK Rehab, (undated). How Addiction Affects Children  
Choate, P. (2011). Adolescent addiction: What parents need?  
Brecker, H. (2008). Alcohol dependence, withdrawal, and relapse  
The National Child Traumatic Stress Network, (2008). Understanding the Links Between Adolescent Trauma and Substance Abuse  
Abbott B., and W, S., PAWS: Post Acute Withdrawal Syndrome, Smart Recovery  
America’s Rehab Campuses. (2020). What Happens to Your Body During Drug Withdrawal?

Drug Wise. (2016). Stimulants

**Notes for the Chapter:**

> Recommended fic exploring this: poly_pr1nce ‘s Doe Eyed Boy (also includes sexual abuse, child grooming, human trafficking and mentions of child pornography) its a cross over with Captive Prince which if you haven't read isn't the most sfw and includes slavery and a lot of child grooming and abuse.


	6. Andrew and Renee - Young Offenders

Exposure to trauma is a fact of life for delinquent youth. More than 90% experience at least 1 traumatic event; more than half (56.8%) are exposed 6 or more times.  
almost one in five young people had significant depressive symptoms, and one in ten reported anxiety or post-traumatic stress symptoms. Self-harm within the past month was reported by almost one in ten young offenders.  
11% of young offenders had alcohol problems and 20% had drug problems. Problems with aggressive behaviour towards people and property were found in about one in four and one in five young people respectively.  
29% of young offenders experiencing difficulties with family relationships and 35% with peers. Educational needs, with poor school attendance and performance difficulties, were found (for those under 16 years old) in 17% and 19% of young offenders respectively. Those over 16 years old fared only slightly better, with education or work needs found in one in ten young people interviewed.  
young offenders from Black and minority ethnic groups had significantly more post-traumatic stress symptoms than those who were White British  
post traumatic stress disorder (PTSD) is more common in youth in the juvenile justice system than in community samples  
92.5%of the sample had experienced at least 1 trauma; 84.0% had experienced more than 1 trauma  
“Among male participants "having seen or heard someone get hurt very badly or be killed" was the most frequent precipitating trauma for PTSD, significantly higher among males (58.9%) than females (23.5%). Among female participants, thinking "you or someone close to you was going to be hurt very badly or die" was the most frequent precipitating trauma, significantly higher among females (27.8%) than males(9.5%)” 

Youth rehabilitation order  
Attendance centre: requires a young person to attend an attendance centre for a specified number of hours and do what they are told to do there by the officer in charge of the centre.  
Activity: requires the young person to participate in a specified activity for up to a total of 90 days.  
Exclusion: this prohibits the young person from entering places specified in the order.  
Drug testing: requires the young person to provide samples at the times specified to make sure they don’t have drugs in their system.  
Drug treatment: requires a young person to submit to treatment by a treatment provider to try to reduce or eliminate their dependency on and/or their propensity to misuse drugs.  
Education: requires the young person to comply with ‘approved education arrangements’, ie, a young person’s education made by their parent or guardian and approved by the local authority specified in the order.  
Curfew: requires the young person to remain indoors at a specified place for specified periods for up to a maximum period of one year. The curfew will include an electronic monitoring requirement unless the court considers it is inappropriate to do so.  
Local authority residence: this requires a young person to live in accommodation provided by, or on behalf of a local authority specified in the order.  
Mental health treatment: requires a young person to submit to treatment for a specified period under the direction of a registered medical practitioner with a view to improving their mental condition.  
Programme: requires a young person to take part in a set of activities as specified in the order. This may include a requirement to live at a specified place if necessary.  
Prohibited activity: the young person must refrain from participating in activities specified in the order on a day (or days) specified or during the period specified.  
Residence: requires the young person to reside with either an individual (who must consent) or at a place specified in the order.  
Supervision: requires the young person to attend appointments as specified by the YOT worker at such times and places as specified by the YOT worker.  
Unpaid work: requires 16 and 17 year olds only (at the time of conviction) to perform unpaid work in the community.  
Intensive fostering requirement: this will only be imposed if the offence was imprisonable and the court feels the offence is ‘so serious’ that a custodial sentence would be appropriate. For a period specified in the order the offender must reside with a local authority foster parent. It must include a supervision requirement.  
Intensive supervision and surveillance: this will only be imposed if the offence was imprisonable and the court feels the offence is ‘so serious’ that a custodial sentence would be appropriate. The order must include supervision; curfew; electronic monitoring; and activity of more than 90 days but not more than 180 days (known as an ‘extended activity’ requirement).

Abran, K., et al. (2004). Posttraumatic Stress Disorder and Trauma in Youth in Juvenile Detention  
Chritsabesan, P., et al. (2018). Mental health needs of young offenders in custody and in the community  
Trevelyan, L. (undated). What is a Youth Rehabilitation Order and when will they come into play?, In Brief


	7. Andrew's drug induced mania (theories)

**Summary for the Chapter:**

> These are just some theories about Andrew's medication and mania. They may not be accurate, I did as much research as I could and asked pharmaceutical and psychology students their opinion resulting in three main theories. If I find out more I may do a pt 2 of theories about this.

If we’re being honest, Andrew’s mania is most likely because Nora Sakavic didn’t do enough research on medical treatment of mental illnesses. Steroids, levodopa and other dopaminergic agents, iproniazid, sympathomimetic amines, triazolobenzodiazepines and hallucinogens were the agents that most commonly induced manic syndromes. 

Antidepressants: 

Off the top of my head drugs such as Sertraline which is the most common treatment for PTSD, depression, anxiety and OCD can on rare occasions cause mania if the patient has bipolar disorder. So it is a possibility that Andrew has bipolar disorder. However this theory is unlikely for two reasons: 1) sertraline is non-addictive, from my experience of them they usually only cause highs whilst adjusting where the user will also experience insomnia and/or nausea. 2) Andrew doesn’t explicitly show any other symptoms of bipolar. He does have depression which is fairly obvious and possibly a symptom of PTSD from years of abuse, gaslighting and grooming. In order for it to have been his hypothetical bipolar disorder reacting to incorrect prescription, he probably would have shown signs of manic-depression before his medication. 

This is not to say it's not a major possibility though. Switches to hypomania or mania occurred in 27% of all bipolar patients treated with SSRIs. 11% of patients switched experienced manic episodes and another 11% experienced hypomania episodes when taking SSRIs. These frequent mood switches associated with acute antidepressant therapy are reduced by lithium treatments. This is more common in patients with hyperthermia (abnormally positive) temperaments, which contradict Andrew’s dysthymia (abnormally negative - see PDD) temperament and apathy. 

Stimulants (dopaminergic receptor agonists): 

Another theory I have is that he was prescribed a stimulant, especially since it was addictive. Amphetamine (speed - usually in adderall) is occasionally used to treat depression (although this is rare) and is an addictive and fairly strong stimulant.If someone is prescribed amphetamines they are used alongside standard antidepressants to treat some types of depression that do not respond to other treatments, especially in people who also experience fatigue and apathy. The apathy side is possibly why Andrew would potentially be court ordered on these. It increases breathing and heart rate, and lessens appetite. Users tend to feel more alert, energetic, confident and less bored or tired. With some people feelings of anxiety, irritability and restlessness are common. The effects of a normal dose lasts for between 4-8 hours and tends to leave the users feeling tired and takes a couple of days to feel “normal” again. Regular amphetamine use can lead to problems eating and sleeping, as well as cause paranoia and lowered resistance to infection. Therefore it's vital for patients taking it to eat well and keep hydrated. Heavy amphetamine use is associated with teeth grinding and resultant dental problems. 

Persistent Depressive Disorder 

With Andrew’s apathy, I would assume he had a disorder such as PDD. Common symptoms of this disorder include sleeping problems, low energy, difficulty concentrating, a lock of interest in daily activities, decreased productivity and avoidance of social activities. The symptoms often begin to appear during adolescence in a display of irritability, behaviour problems, poor school performance and difficulty with interpersonal relationships and social situations. The chronic nature of this condition can make it extremely difficult to deal with, but the possible cause the condition is usually inherited or as an effect of trauma or other mental health conditions such as chronic anxiety and bipolar disorder. Common medication treatment through antidepressant include:  
\- selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac) and sertraline (Zoloft)  
\- tricyclic antidepressants (TCAs), such as amitriptyline (Elavil) and amoxapine (Asendin)  
\- serotonin and norepinephrine reuptake inhibitors (SNRIs), such as desvenlafaxine (Pristiq) and duloxetine (Cymbalta)

Drug Wise. (2016). Amphetamine (https://www.drugwise.org.uk/amphetamines/)  
Crohol, J., (2016). Manic Episode Symptoms  
Sultzer DL, Cummings JL. Drug-induced mania--causative agents, clinical characteristics and management. A retrospective analysis of the literature  
Osser, DN., (2019). Hyperthymic Temperament

More information about mood changing drugs in aftg from a Forensic Mental Health professional: https://nickireadstfc.tumblr.com/post/159566116785/hey-there-re-meds-in-tfc-i-work-in-forensic

**Notes for the Chapter:**

> I've finally finished my finals and assignments and have next week off to research and write as much as I want. I'm planning to look into describing fighting techniques because whilst I have experience I have never really thought about how to explain them in words. If anyone wants particular information or has theories I'd love to hear about them!


	8. Neil - youth homelessness

**Summary for the Chapter:**

> Very brief statistics and comparisons of different homeless youth. Ideally I would have been able to find more about runaway mentalities but what I did find was unhelpful.

Between 36,000 and 52,000 young people in London were found homeless. Of these numbers, roughly 4,700-6,700 individuals (13%) were sleeping rough. These figures are and always will be inaccurate as they do not count hidden homelessness. Hidden populations of people experiencing homelessness include those who live in overcrowded conditions, those who stay with friends and relatives or in night shelters and hostels, and those who sleep rough away from the outreach services. Neil would have most likely gone through many different experiences of hidden homelessness whilst on the run. From house squatting in book 1, living in cheap hostels or sharing residence in cheap, over crowded shared apartments. It is important to also remember Neil would have still experienced white and cisgender privilege. He would have found it safer to sleep rough than someone who was POC in the same situation. If he was caught, there would have been less life threatening consequences from police and communities.

It is thought that an underlying reason for the higher prevalence of homelessness among people from ethnic minority backgrounds is that they are more likely to experience the risk factors associated with homelessness and face multifaceted deprivation than white people (ODPM; 2005). According to Sommerville et al (2001) emerging key factors that explain the increased likelihood of homelessness for BME people include the extended nature of many BME families, which can result in overcrowding in housing stock, experiences of social exclusion and racism, low incomes, unemployment, limited housing opportunities in the right location and a lack of cultural awareness among housing staff. Neil is also not canonically trans, meaning his experience would most likely not be anywhere near the experience of the large percentage of homeless queer youth who are turned away from accommodation options because of their identity. 

Although his mum and he often were illegal immigrants they would most likely not experience the same prejudice. Section 55 of the Nationality, Immigration and Asylum Act (2002) provides opportunity for authorities to no longer have obligatory responsibilities if an application for asylum is not made as soon as reasonably practicable after entering the UK. In 2003, nine thousand individuals were refused support as a result of Section 55 and a common consequence of this action was homelessness (Refugee Council 2004). Because they do not enter countries openly seeking asylum from any war zone or political unrest and because of their ability to purchase fake IDs and pay off those who would alert authorities, laws such as section 55 would most likely not affect them. However I still think it is important to understand as for the most part I imagine they would have crossed paths and lived with a vast array of other homeless people, and people living in poverty. 

Mental health problems commonly precipitated and are made worse by homelessness and typically present within socially disadvantaged groups. Young people now have more intense exposure to high-risk behaviours including alcohol and drug use, availability of financial credit and sexual activity. On top of this is the seemingly ever present encouragement from the media toward increasing maturity at an earlier age. Whilst most young people harness these freedoms and opportunities constructively, for others this period of transition is difficult and risky. Furthermore, disadvantage at this transitional point can have devastating consequences throughout a person’s life (Social Exclusion Unit [SEU] 2005). It is estimated that between 30%-50% of people experiencing homelessness have mental health problems compared with 10%-24% of the general population (Warnes et al 2003). Whilst homelessness is likely to create or worsen mental health problems, it is also a product of mental illness. 

Mental Health Foundation, Making the link between mental health and youth homelessness [online]. https://www.mentalhealth.org.uk/sites/default/files/making_the_link.pdf  
Warnes, A,. et al. (2003) Homelessness Fact File. London: Crisis  
Warnes, A., et al. (2005) London’s Hostels for Homeless People in the Twentieth Century. University of Sheffield  
Refugee Council (2004) Hungry and Homeless: The impact of the withdrawal of state support on asylum seekers, refugee communities and the voluntary sector. London: Refugee Council  
SAMHSA (2020), Youth. https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/youth  
Snow, B., (2017). Here’s the real story of homelessness and domestic abuse that the statistics hide. The Guardian. https://www.theguardian.com/housing-network/2017/dec/15/statistics-homelessness-domestic-abuse  
Women’s aid., (2019). Women escaping domestic abuse left at risk of homelessness. https://www.womensaid.org.uk/women-escaping-domestic-abuse-left-at-risk-of-homelessness/


	9. Kevin - Complicated Grief

**Summary for the Chapter:**

> the complexity of grieving abusers in reference to Kevin and Riko. This can be just as applicable to Neil and Aaron and their mothers, and to Nicky and his parents. You could also possibly look into this from the perspective of Matt and his father after moving out of his father's care, or Allison and being disowned by her family.

I think most people have probably experienced grief of one type or another especially when you live the lives the Foxes do. All people deal with loss and grief differently but it's hard to control your emotions. There are five main phases of grief:   
\- Denial: feeling numb, like everything is a dream, not quite believing someone has passed   
\- Anger: feelings of frustration and helplessness as you are forced to face the reality of the pain of your loss. This can be at others, at the person you have lost, frustration and anger at yourself   
\- Bargaining: this is the thoughts of ‘what if’, dwelling on what could’ve happened to prevent the loss   
\- Depression: crying, sleep issues, and a decreased appetite.   
\- Acceptance: accepting the reality of your loss. You will continue to feel sad but have begun to find stability and move forward. 

The phases are not linear. It is fairly usual for people to jump back and forwards, or to take two steps forward, one step back in their progress. Reminders of loss like anniversaries or songs can trigger the return of grief. There is no “normal” time period people tend to grieve. The type of loss will influence this for example the sudden death of a loved one versus having your heart broken at the end of a romantic relationship or moving away from close family and friends. 

In the case of Kevin’s grief for Riko, the grief is a little more complicated. Grief isn’t about whether people in our lives were “good” or “bad”, if someone was a part of your life as much as Riko was in Kevin’s it's natural he would grieve. As readers its understandable that many of us would not understand this, for one it's unlikely we grew up in the same environment as Kevin and for second we only see the narrative from Neil’s perspective. Flip the point of view and we see the complexity abusive relationships have in people's lives. It is not just the relationship and weird pseudo-familial bond they had, but also his hopes and expectations of being loved by the closest thing he had to a family growing up. 

I think the best way I can illustrate this is from a milder personal example. I cut all ties with a close friend after college, blocking him in every way I possibly could. He was abusive, gaslighting me and constantly blaming me for his poor mental health. I still get pangs of regret, of complete hopelessness when thinking what could have been if only I had tried harder or been a stronger person. Death and loss is not something new to me, I’ve experienced it constantly as a child and have carried the uncertainty of getting close to people if it would only cause me pain with me. Although this friend hurt me a great deal, you will feel like you missed out on what could have been. The ‘if only’ and ‘what if’ of bargaining sticks around even after you try to accept the loss.

Kevin’s obsession with exy is possibly another example of his grieving, after leaving the Nest he carries the only enjoyable experience from his childhood with him. His drinking and substance abuse, again, is him being stuck in this bargaining phase. He could not have this dream life he wanted, and the closest familial relationships he had are killed before he can come to terms and heal from the abuse. There’s still a lot of research to be done before anyone can identify why grief becomes complicate, but there are some issues that researchers agree can contribute such as the circumstances of the loss, the relationship with the person who has died, other losses (particularly at an early age), and the personality of the individual who has experienced the loss. Existing mental health conditions can create extra challenges for people trying to cope with their grieving. 

Another example from Topps (2019) who experienced the grief of the death of her ex-fiance who was emotionally abusive to her: “The next couple of months were excruciating. I was mourning in silence, full of gut-wrenching shame about grieving the death of a man who emotionally abused me. My anxiety triggered insomnia, and I was reluctant to share my feelings with my wife. I was suddenly struck by a plethora of questions: Did he know how badly he’d hurt me? Had he been remorseful? Did he ever get professional help?” Grieving the death of abusers means reliving the anxiety, fear, insecurities, and depression inflicted upon the griever. It triggers memories people have not thought about in years and return old thinking patterns, feelings and reactions. It can be especially complicated if the abuse caused any PTSD for additional mental health issues. Frequent panic attacks, uncertainty etc. is common. It is also further complicated in Kevin’s case because his whole life was dictated by Riko. Even after leaving the Nest, Kevin was constantly controlled via fear. At Riko’s death, Kevin suddenly has the autonomy over his life he has never had before. 

Grief doesn’t necessarily ever stop. Instead it becomes more manageable. Grief is completely individual a, people who are bereaved can sometimes feel pressure from those around them to ‘move on’ (i.e. Andrew and Neil in the case of Kevin) but grieving takes times and is not a linear process. The more dysfunctional the relationship, the more complicated the grieving process. Remember the loss or death of someone is a traumatic experience and it is likely they will experience the symptoms of complex trauma along with this. 

WebMD, What Is Normal Grieving, and What are the Stages of Grief? https://www.webmd.com/balance/normal-grieving-and-stages-of-grief#1   
Forsythia, S., (2018). On Grieving Toxic People, Abusers, and Assholes [blog]. https://medium.com/@shelbyforsythia/on-grieving-toxic-people-abusers-and-assholes-236e8393b948   
Cruse Bereavement Care. About complicated grief. https://www.cruse.org.uk/complicated-grief   
Topps, J., (2019). The Complex Process of Grieving Your Abuser. Allure [blog]. https://www.allure.com/story/grieving-abuser-death   
Oliveira, P., (2015). Complicated Grief: Grieving the Loss of Your Perpetrator. Huff Post [blog]. https://www.huffpost.com/entry/complicated-grief-grievin_b_6209114?guccounter=1&guce_referrer=aHR0cHM6Ly93d3cuZ29vZ2xlLmNvbS8&guce_referrer_sig=AQAAAItPtIMx0zgw-xXpt5gSWI5dFHxLC2xw_rIUjHOJmsTtVMw-NkCm4vk-mEZXYK9GpItqNNucXC9gJhPvgVgWE_ekc9vWfTTNCzPqPXzYLXlZZBmDFEPprm_NaFiuOJiVthZSus7tf6-YgS42nDDDnH3cFr8scsEj4DSMINfNx1TH


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